Cortical “ribbon sign” on DWI in adults: A case report and literature review

doi:10.3969/j.issn.1004-583X.2024.09.010

Abstract

Abstract:

Objective To investigate the clinical characteristics of cortical “ribbon sign” on diffusion-weighted imaging (DWI). Methods The clinical data, relevant examination data, and imaging data of a case of cortical “ribbon sign” were analyzed, and relevant literatures were reviewed. Results The patient was admitted to the hospital due to involuntary grasping of objects with a walking instability for 10 days, and aggravated for 2 days. Brain imaging examination showed cortical “ribbon sign”, manifesting as a high signal intensity along the cerebral sulcus on T1-weighted imaging, DWI and fluid-attenuated inversion recovery sequence. The increase in signal intensity was pronounced on DWI sequence, reflecting the cytotoxic edema of the cerebral cortex. Symptomatic treatment was performed. The patient's symptoms gradually worsened and died about half a year later. Conclusion Cortical ribbon sign is a typical imaging change of laminar necrosis of the cerebral cortex, usually observed in vascular, infectious, metabolic, and toxic nerve system diseases. A deep mining of the pathogenesis and causes of cortical ribbon sign favors the clinical diagnosis and differentiation diagnosis.

Key words: cerebral cortex, ribbon sign, cortical laminar necrosis, magnetic resonance imaging, differentiation diagnosis

CLC Number:

R445.2

Zhang Yingqiu, Zhang Jin, Ge Shihao, Chen Junmin. Cortical “ribbon sign” on DWI in adults: A case report and literature review[J]. Clinical Focus, 2024, 39(9): 821-824.

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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2024.09.010

https://huicui.hebmu.edu.cn/EN/Y2024/V39/I9/821

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References 30

[1]	Siskas N, Lefkopoulos A, Ioannidis I, et al. Cortical laminar necrosis in brain infarcts: Serial mri[J]. Neuroradiology, 2003, 45(5): 283-288. pmid: 12743663
[2]	Abdulmassih R, Min Z. An ominous radiographic feature: Cortical ribbon sign[J]. Intern Emerg Med, 2016, 11(2): 281-283. doi: 10.1007/s11739-015-1287-4 pmid: 26238299
[3]	Ishigaki H, Sato N, Kimura Y, et al. Linear cortical cystic lesions: Characteristic mr findings in melas patients[J]. Brain Dev, 2021, 43(9): 931-938.
[4]	Sharma SR, Massaraf H, Das S, et al. Cortical laminar necrosis as a presenting manifestation of migraine in an apparently normal patient: A rare case report[J]. J Neurosci Rural Pract, 2019, 10(3): 559-562. doi: 10.1055/s-0039-1698009 pmid: 31616131
[5]	Wang Z, Qin W, Lyu Y, et al. Prevalence and prognostic factors of cortical laminar necrosis in acuteischemic stroke[J]. Curr Neurovasc Res, 2023, 20(2): 183-189.
[6]	Yaginuma K, Watanabe M, Suzuki Y, et al. Cortical laminar necrosis in an infant with influenza a virus infection[J]. Clinical Case Reports, 2020, 8(9): 1843-1844. doi: 10.1002/ccr3.2936 pmid: 32983513
[7]	Xu L, Ma L, Fu G. Massive cerebral air embolism with very early cortical laminar necrosis[J]. Stroke, 2022, 53(6): e228-e229.
[8]	Schatlo B, Dreier JP, Gläsker S, et al. Report of selective cortical infarcts in the primate clot model of vasospasm after subarachnoid hemorrhage[J]. Neurosurgery, 2010, 67(3): 721-729. doi: 10.1227/01.NEU.0000378024.70848.8F pmid: 20651629
[9]	Schinke C, Horst V, Schlemm L, et al. A case report of delayed cortical infarction adjacent to sulcal clots after traumatic subarachnoid hemorrhage in the absence of proximal vasospasm[J]. BMC Neurology, 2018, 18(1): 210.
[10]	Stefan W, Vatter H, Beck J, et al. Focal laminar cortical infarcts following aneurysmal subarachnoid haemorrhage[J]. Neuroradiology, 2008, 50(1): 1-8. doi: 10.1007/s00234-007-0294-1 pmid: 17922121
[11]	Juneja A, Anand K. Cortical laminar necrosis in hsv-1 encephalitis[J]. Neurol India, 2021, 69(4): 1136.
[12]	Tanaka J, Nakamura H, Fukada T. Adult-onset subacute sclerosing panencephalitis: Immunocytochemical and electron microscopic demonstration of the viral antigen[J]. Clin Neuropathol, 1987, 6(1): 30-37. pmid: 3552353
[13]	Vera CN, Linam WM, Gadde JA, et al. Congenital toxoplasmosis presenting as eosinophilic encephalomyelitis with spinal cord hemorrhage[J]. Pediatrics, 2020, 145(2): e20191425.
[14]	Garg RK, Rizvi I, Ingole R, et al. Cortical laminar necrosis in dengue encephalitis-a case report[J]. BMC Neurology, 2017, 17(1): 79.
[15]	Akçay N, Bektaş G, Menentoğlu ME, et al. COVID-19-associated acute disseminated encephalomyelitis-like disease in 2 children[J]. Pediatr Infect Dis J, 2021, 40(11): e445-e450.
[16]	Bhatia KD, Krishnan P, Kortman H, et al. Acute cortical lesions in melas syndrome: Anatomic distribution, symmetry, and evolution[J]. AJNR Am J Neuroradiol, 2020, 41(1): 167-173.
[17]	Ogul H, Pirimoglu B, Kantarci M. Unusual mri findings in a girl with acute hepatic encephalopathy: Leptomeningeal enhancement and cortical laminar necrosis[J]. Acta Neurol Belg, 2015, 115(4): 697-698. doi: 10.1007/s13760-015-0436-x pmid: 25656941
[18]	Choi JM, Kim YH, Roh SY. Acute hepatic encephalopathy presenting as cortical laminar necrosis: Case report[J]. Korean J Radiol, 2013, 14(2): 324.
[19]	Mironova D, Benjamin P, Zacharoulis S, et al. Cortical laminar necrosis mimicking leptomeningeal recurrence in a child with medulloblastoma and epilepsy[J]. Pediatr Blood Cancer, 2023, 70(11): e30641.
[20]	Balola C, Nzabara F, Tshongo Muhindo C, et al. Epilepsia partialis continua associated with ketotic hyperglycemia and tuberculous meningoencephalitis: A case report[J]. Clin Case Rep, 2022, 10(2): e05460.
[21]	Mariajoseph FP, Sagar P, Muthusamy S, et al. Seizure-induced reversible mri abnormalities in status epilepticus: A systematic review[J]. Seizure, 2021, 92: 166-173. doi: 10.1016/j.seizure.2021.09.002 pmid: 34525432
[22]	Wu L, Jin D, Sun X, et al. Cortical damage in wernicke’s encephalopathy with good prognosis: A report of two cases and literature review[J]. Metab Brain Dis, 2017, 32(2): 377-384.
[23]	Liu X, Zhao X, Yang J, et al. Cortical laminar necrosis following the rapid correction of drug-induced hyponatremia[J]. Neurol Sci, 2015, 36(9): 1725-1727. doi: 10.1007/s10072-015-2250-x pmid: 25981229
[24]	Aiba Y, Sakakibara R, Katsumata M, et al. Diffuse cortical injury by hypoglycemia[J]. Intern Med, 2019, 58(16): 2415.
[25]	Galvez C, Krall P, Rojas A, et al. HUS with mutations in cfh and stec infection treated with eculizumab in a 4-year-old girl[J]. Pediatr Nephrol, 2023, 38(4): 1195-1203.
[26]	Akiko K, Saito Y, Seki A, et al. Delayed neuropsychiatric syndrome in a child following carbon monoxide poisoning[J]. Brain Dev, 2007, 29(3): 174-177.
[27]	Arnold SM, Els T, Spreer J, et al. Acute hepatic encephalopathy with diffuse cortical lesions[J]. Neuroradiology, 2001, 43(7): 551-554. doi: 10.1007/s002340000461 pmid: 11512584
[28]	Goel D, Reddy SR, Sundaram C, et al. Active necrotizing cerebral vasculitis in systemic lupus erythematosus[J]. Neuropathology, 2007, 27(6): 561-565. pmid: 18021377
[29]	Kumarasamy S, Agrawal D. Cortical laminar necrosis in a child with severe traumatic brain injury on computed tomography scan[J]. Neurol India, 2023, 71(3): 611.
[30]	Xiang X, Cao F. Cortical laminar necrosis in a patient with an embolic stroke of undetermined source: The metabolism patterns on pet/ct[J]. Neurol Sci, 2021, 42(11): 4785-4788.